Cost Effectiveness of the Aprofam Program for Voluntary Surgical Contraception in Guatemala

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Abstract
This study examines the relative cost effectiveness of five alternative service delivery methods for providing voluntary surgical contraception (VSC) in Guatemala. The study focuses primarily on the relative effectiveness of providing VSC in the country's interior using fixed facilities with local doctors or mobile teams. A retrospective cost-effectiveness analysis finds that the mobile teams are relatively more expensive than using local doctors. This result was tempered by an analysis of the monthly cost and service statistics using statistical cost techniques. The alternative approach explicitly recognizes the dynamic nature of a family planning organization by relating the variations in monthly program costs to the monthly variations in service levels. The alternative analysis revealed that, at the margin, with the given stock of capital the mobile teams are relatively cheaper to use, and that the fixed facilities need high demand levels (which are unlikely to occur in the interior) to achieve low costs at the margin. The alternative analysis led to the funding agency retaining the mobile team model.

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